Intended for healthcare professionals

Clinical Review State of the Art Review

Initial management of Parkinson’s disease

BMJ 2014; 349 doi: (Published 19 December 2014) Cite this as: BMJ 2014;349:g6258
  1. Christopher G Goetz, professor of neurological sciences1,
  2. Gian Pal, assistant professor of neurological sciences1
  1. 1Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
  1. Correspondence to: G Pal gian_d_pal{at}


Parkinson’s disease is one of the most common neurodegenerative disorders seen in the United States and United Kingdom. The disease is characterised by two processes—cellular degeneration and the resulting biochemical deficiency of dopamine. Although these processes are inter-related, they are approached separately in the clinical setting. Currently, no proven neuroprotective or disease modifying treatment is available for Parkinson’s disease. Several agents can be used to treat the motor symptoms associated with dopamine deficiency, and it is important to choose wisely when starting treatment. Drugs can have mild, moderate, or high potency, and the patient’s goals, comorbidities, and the short and long term implications of choosing a specific agent should be taken into account when selecting the appropriate agent. Non-motor symptoms, such as depression, fatigue, and disorders of sleep and wakefulness, also need to be evaluated and treated. Research is under way to deliver dopaminergic therapy more effectively, but studies aimed at slowing or stopping disease progression have not shown promise.


  • Contributors: CG conceived the article, helped prepare the manuscript, and critically reviewed it. GP drafted the manuscript, helped prepare it and is guarantor.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: none.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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